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Predictive plain X-ray findings in distinguishing early stage acute lymphoblastic leukemia from juvenile idiopathic arthritis
Clinical Rheumatology, 07/29/09

Tafaghodi F et al. – Acute lymphoblastic leukemia (ALL) presenting with musculoskeletal pain may be difficult to distinguish from juvenile idiopathic arthritis (JIA). Data suggest that the plain X-ray may be useful in selecting patients requiring bone marrow examination among those presenting with musculoskeletal symptoms mimicking JIA.

Methods

Main objectives of this study were to:
- Determine the role of plain radiography in the initial approach toward pts presenting with musculoskeletal symptoms, and
- Look for signs suggestive of each of the 2 disease entities (ALL and JIA)
X-rays of pts diagnosed with JIA or ALL over a period of 10 yrs were studied retrospectively
X-rays was performed in the preliminary stage of the disease process and before the initiation of specific therapeutic measures
Soft tissue swelling, osteopenia, radiolucent metaphyseal bands, coarse trabeculation, and periosteal reactions were studied
Data analysis was performed by SPSS

Results

174 pts; 118 had been diagnosed with JIA and 56 with ALL
Average age of JIA pts and ALL pts were 7.5 and 7.2 yrs, respectively
Soft tissue swelling was more common among JIA pts vs those with ALL
Therefore, it is important to note the presence or absence of soft tissue swelling on plain radiography in the initial diagnostic approach
Osteopenia was seen in 60.2% of JIA pts vs 14.3% of ALL pts
Radiolucent metaphyseal bands were seen among 7.1% of ALL cases but were absent in all cases of JIA
Coarse trabeculation was higher in pts with ALL vs JIA pts
Periosteal reactions were seen in 6.8% of JIA group vs 1.8% of ALL pts

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